Regional manual therapy and motor control exercise for the management of chronic low back pain with hip and spine motion loss: A randomized clinical trial
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Background: The purpose of this study was to determine the additive effects of regional thoracic, pelvic, and hip manual therapy to standard physical therapy (PT) for improving spine and hip range of motion (ROM), pain intensity, disability level, and perceived change in a homogenous subgroup of persons with chronic low back pain (CLBP) and movement coordination impairments. Methods: Forty participants with CLBP and movement coordination impairments were randomly allocated into one of two treatment groups. The control group received standard PT, consisting of a motor control exercise program and local lumbar spine manual therapy. The experimental group received standard PT and regional manual therapy applied to the hips, pelvis, and thoracic spine. Both groups received treatment at an outpatient clinic twice a week for four weeks. Outcome measures included thoracic and lumbar spine sagittal plane ROM, hip ROM in the transverse and sagittal planes, pain intensity measured with the Numeric Pain Rating Scale (NPRS), disability level measured with the Modified Oswestry Low Back Pain Disability Questionnaire (ODQ), and perceived change due to treatment measured with the Global Rating of Change (GROC) scale. All outcome measures were assessed at two weeks, four weeks, and 12 weeks from the start of treatment. A MANOVA with repeated measures was used to analyze spine and hip ROM (α = 0.05). Two separate ANOVAs with repeated measures were used to analyze pain intensity and disability level (α = 0.05). A Mann-Whitney U test was used to analyze GROC scores (α = 0.05). Results: There was no significant interaction for group by time for spine and hip ROM, pain intensity, or disability level, suggesting that there was no difference between groups for any of these variables over 12 weeks. A significant difference was found in the main effect of time for hip ROM (p < 0.001), pain intensity (p < 0.001), and disability level (p < 0.001), suggesting that both groups demonstrated an improvement in these variables across time. No significant difference was found in the main effect of time for spine ROM (p = 0.105). A significant difference was found between groups at all three time points for the GROC, with the regional manual therapy plus standard PT group demonstrating higher perceived change scores at two weeks (p = 0.031), four weeks (p = 0.022), and 12 weeks (p = 0.047). Conclusion: A program of standard PT with or without regional manual therapy resulted in significant improvements in hip ROM, pain intensity, and disability level across time in a homogenous subgroup of persons with CLBP and movement coordination impairments. The addition of regional manual therapy to a program of standard PT resulted in significantly higher GROC scores across time compared to a program of standard PT alone.